The importance of having a plastic surgeon on your breast cancer team

Navigating a breast cancer diagnosis can be an all-consuming experience. Whether processing the news, preparing for a mastectomy or going through chemotherapy, the process often takes over every facet of your life, and likely, the last thing on your mind is reconstructive surgery.

In fact, despite the continued destigmatization of plastic surgery, the growing number of resources for breast cancer treatment and prevention – and even the fact that health insurance is legally required to cover the costs of reconstruction after breast cancer – less than half of all women who require mastectomy were offered breast reconstruction surgery as of 2017, and fewer than 20 percent opted for immediate reconstruction.

In reality, undergoing reconstruction following mastectomy can make a world of difference for patients' health and wellbeing, and it can help ease what is typically a very difficult time.

"I can't fathom facing breast cancer in any capacity without having a plastic surgeon involved," says Dr. Emily McLaughlin, a board-certified plastic surgeon in Fort Worth, Texas. "The idea that they would not be a part of the team approaching this is just crazy to me."

In most cases, the breast surgeon who performs a mastectomy will continue to play a role in patients' recovery, but the major relationship moving forward will be with their plastic surgeon.

"That's who puts you back together, whether it's with flaps, expanders or implants," Dr. McLaughlin explains. "On the other side of breast cancer, when you're looking in the mirror, I guarantee you most patients are not thinking about their breast surgeon; they're thinking about the plastic surgeon who helped them resume some semblance of normalcy."

It's not enough to work with a plastic surgeon after the fact. It's imperative that they be on your breast cancer team from the very beginning. This enables the surgeon to start a dialogue with patients about their goals and to see what they're working with – and will recreate – before the breast tissue is actually gone.

Perhaps most importantly, having a plastic surgeon on your team allows him or her to be a part of the planning throughout, which can drastically shorten the timeline for reconstruction surgery.

"For the most part, reconstruction happens concurrently with mastectomy, so it's just proper planning for the breast surgeon to incorporate the plastic surgeon sooner rather than later," Dr. McLaughlin says.

"I used to see so many patients come in after having their mastectomies and radiation, but they had never seen a plastic surgeon and didn't know they could have had breast reconstruction at the time of their surgery," says Dr. Lynn Jeffers, the immediate-past president of ASPS, and a co-founder of the Integrated Breast Center at St. John's. "It's not just a matter of convenience of having the surgeries done at the same time. Sometimes, because of the treatments they'd already had, like radiation, certain reconstructive options would no longer be available to them."

Historically, when patients had mastectomies, plastic surgeons would need to put a tissue expander behind the pectoralis muscle since the breast tissue no longer existed. This often led to animation deformity, which moves implants every time the pectoralis muscles are flexed. In recent years, however, standards have improved considerably, and well-planned modern reconstruction is now pre-pectoral (in front of the muscle), so surgeons can go straight to the implant in many cases.

"It's a game-changer because you can avoid the expander and weeks of expansion and then another operation," Dr. McLaughlin says. "In some instances, with proper planning, patients can wake up from their mastectomies with implant reconstruction."

Working with a plastic surgeon can also offer breast cancer patients a much-needed sense of hope in the midst of an impossibly trying time.

"For breast cancer patients, this is an essential part of their lives and themselves and feeling whole again," Dr. Jeffers says. "Our whole job is to tell patients what's possible, what we can do and what it will be like and to hopefully restore a sense of normalcy when their whole worlds have been upended by this cancer diagnosis."

Reconstruction can even serve as something to look forward to or a chance to improve a previous insecurity.

"What I always tell my patients is that nobody wants breast cancer and nobody signs up for breast cancer, but sometimes when you meet with your plastic surgeon, you realize it's an opportunity," Dr. McLaughin says. "For the longest time, before modern reconstruction, patients just accepted mediocrity, but standards are now so high that it's not just about having breasts, it's about having beautiful breasts. The bar has been raised, and the line between reconstruction and aesthetic surgery has blurred, so patients expect more from it, as they should."

To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.